BACKGROUND Previous intervention studies among night workers mainly focused on single interventions and found inconclusive evidence for effectiveness. A comprehensive intervention approach that includes individual and environmental components has been argued as important. Gaining insight into contributing factors for the implementation of interventions for night workers and effectiveness is important to distinguish between theory and programme failure. OBJECTIVES To evaluate the effects and implementation of the PerfectFit@Night intervention to improve sleep, fatigue and recovery of night workers in healthcare, using the RE-AIM framework, which assesses reach, effectiveness, adoption, implementation and maintenance of interventions. DESIGN A prospective pre-post study design, with two measurements before and three and six months after the intervention. SETTING Twelve different departments of a university hospital in the Netherlands. PARTICIPANTS Healthcare workers working night shifts (n = 210). METHODS PerfectFit@Night consisted of environmental (provision of a powernap bed and healthy food, and workshop healthy rostering) and individual elements (e-learning and sleep coaching) and was implemented for three months in a phased manner. Questionnaires, logbooks and interview data were used. Effects of the intervention on sleep, fatigue and recovery were evaluated with mixed-effects models, and implementation factors of reach, adoption, implementation and maintenance were evaluated. RESULTS Night shift-related insomnia (-11 %-points, 95 % CI: -19 %, -4 % at three months), need for recovery (β: -2.45, 95 % CI: -4.86, -0.03 at six months) and fatigue (OR: 0.46, 95 % CI: 0.25, 0.86 at six months) decreased significantly after the intervention. No changes were found for subjective sleep quality and sleep duration. Barriers and facilitators for implementation were identified for each intervention element at individual (e.g., dietary preferences), organisational (e.g., responsibilities at work) and workplace levels (e.g., location of power nap bed), and for the intervention itself (e.g., useful information in e-learning). Although satisfaction was high and continuation was preferred, embedding of the intervention in the daily routine was limited. Facilitators for future implementation include a positive attitude towards the intervention, clear guidelines regarding intervention elements, appointment of night workers as ambassadors, and suitable conditions in terms of work demands and for the intervention elements. CONCLUSIONS The multi-faceted PerfectFit@Night intervention reduced insomnia, fatigue and need for recovery in night workers in healthcare. The most important facilitators to improve the implementation of PerfectFit@Night exist at the organisational level (e.g., positive attitude within the culture and suitable work demands). Combining effect and implementation evaluation is crucial to identify barriers and facilitators that hamper or enhance intervention effects. TRIAL REGISTRATION The study was registered in the Netherlands Trial Register on 17 January 2021 (trial number NL9224).

中文翻译：

---

改善夜班医护人员睡眠、疲劳和恢复的干预措施的效果和实施：一项前后测试研究。


背景 此前对夜班工人的干预研究主要集中于单一干预措施，并没有发现有效的证据。人们认为，包括个人和环境因素在内的综合干预方法非常重要。深入了解对夜班工人实施干预措施的影响因素和有效性对于区分理论失败和计划失败非常重要。目标 使用 RE-AIM 框架评估 PerfectFit@Night 干预措施对改善医疗保健夜班工作人员的睡眠、疲劳和恢复的效果和实施情况，该框架评估干预措施的范围、有效性、采用、实施和维护。设计 前瞻性前后研究设计，在干预前以及干预后三个月和六个月进行两次测量。场景 荷兰一所大学医院的十二个不同科室。参与者 夜班医护人员（n = 210）。方法 PerfectFit@Night 包括环境要素（提供小睡床和健康食品以及车间健康排班）和个人要素（电子学习和睡眠辅导），并分阶段实施三个月。使用了问卷、日志和访谈数据。使用混合效应模型评估干预措施对睡眠、疲劳和恢复的影响，并评估影响范围、采用、实施和维持的实施因素。结果 夜班相关失眠（-11 % 点，95 % CI：-19 %，三个月时-4 %），需要恢复（β：-2.45，95 % CI：-4.86，六个月时-0.03） ）和疲劳（六个月时 OR：0.46，95% CI：0.25，0.86）在干预后显着下降。 主观睡眠质量和睡眠持续时间没有发现变化。针对个人（例如，饮食偏好）、组织（例如，工作职责）和工作场所（例如，动力午睡床的位置）以及干预本身（例如，有用的功能）的每个干预要素，确定了实施的障碍和促进因素。电子学习中的信息）。尽管满意度很高并且首选继续治疗，但干预措施在日常生活中的嵌入程度有限。未来实施的促进因素包括对干预的积极态度、干预要素的明确指导方针、任命夜班工人为大使、以及工作需求和干预要素的适当条件。结论 多方面的 PerfectFit@Night 干预措施减少了医疗保健夜班工作人员的失眠、疲劳和恢复需求。改善 PerfectFit@Night 实施的最重要的促进因素存在于组织层面（例如，文化中的积极态度和适当的工作要求）。将效果和实施评估结合起来对于识别阻碍或增强干预效果的障碍和促进因素至关重要。试验注册 该研究于 2021 年 1 月 17 日在荷兰试验登记处注册（试验号 NL9224）。